Michael E Deitz, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD21436 Issued in WA

Practice address

475 Bradley Blvd
Richland, WA 99352-4419

Phone

(509) 943-2240

Fax

(509) 943-1575

NPI assigned

Dec 20, 2005

Last updated

Feb 15, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Full Spectrum Eye Care, P.S.

  dba The Columbia River Eye Center Optical Shop

  • Eyewear Supplier
  • Richland, WA
  • NPI 1144317983
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203033600000",
    "number": "1285610378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 BRADLEY BLVD",
            "city": "RICHLAND",
            "state": "WA",
            "postal_code": "993524419",
            "telephone_number": "509-943-2240",
            "fax_number": "509-943-1575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 BRADLEY BLVD",
            "city": "RICHLAND",
            "state": "WA",
            "postal_code": "993524419",
            "telephone_number": "509-943-2240",
            "fax_number": "509-943-1575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEITZ",
        "first_name": "MICHAEL",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-20",
        "last_updated": "2008-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "MD21436",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMUNITY HEALTH PLAN",
            "identifier": "1004901",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1011998",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5438375",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "152595",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "26051",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "350230",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH",
            "identifier": "314",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Armelia J Dean, LMHC
• Shelly Nicole Deery, LMP
• Tracy Candace W. Degenstein, ARNP
• Constance Jean Dehaan, LMP
• Lauren Elizabeth Deichman, PA-C
• Dara Nadine Dejong, BSN, RN
• Jonathan D. Del Mundo, DO
• Deluna Counseling and Art Therapy PLLC (DeLuna Counseling and Art Therapy)
• Sean Michael Demars, M.D.
• Pamela Denning, RN

• Specialist in Richland, WA
• Providers in Richland, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.